Surgical management of post-myocardial infarction ventricular tachyarrhythmia by myocardial debulking, septal isolation, and myocardial revascularization

H. Bolooki, G. M. Palatianos, L. Zaman, Richard J Thurer, R. M. Luceri, Robert J Myerburg

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Sustained ventricular tachycardia or ventricular fibrillation, associated with severely depressed left ventricular function after myocardial infarction, carried a poor prognosis. We have used an extensive surgical procedure in 18 patients (15 men and three women) with a mean age of 63 years who had more than three episodes of recurrent, hemodynamically significant ventricular tachycardia or fibrillation and congestive heart failure. The operation consisted of complete myocardial revascularization and myocardial debulking by extensive infarctectomy with unguided endocardial resection and septal isolation with support of the necrotic wall with a Teflon patch. Implantable defibrillator patches were placed in eight patients. Blood cardioplegia and intra-aortic balloon assist (12 patients) were used for perioperative myocardial preservation. Postoperative studies demonstrated a significant increase in ejection fraction (n = 16) and a decline in pulmonary wedge pressure. Hospital mortality was 16% (three patients). Two deaths were due to congestive heart failure and one to arrhythmia. During postoperative electrophysiologic studies, ventricular tachycardia was not inducible in six of eight patients (75%). During a mean follow-up of 24 months, 11 of 15 patients who survived operation are alive and are in New York Heart Association Class I or II. Three of four late deaths were due to congestive heart failure and drug toxicity and one was arrhythmia related. This procedure is effective for preventing recurrent ventricular tachycardia or fibrillation in a majority of patients who cannot have intraoperative mapping.

Original languageEnglish
Pages (from-to)716-725
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume92
Issue number4
StatePublished - Dec 1 1986
Externally publishedYes

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Myocardial Revascularization
Tachycardia
Myocardial Infarction
Ventricular Tachycardia
Ventricular Fibrillation
Heart Failure
Cardiac Arrhythmias
Induced Heart Arrest
Pulmonary Wedge Pressure
Implantable Defibrillators
Polytetrafluoroethylene
Hospital Mortality
Drug-Related Side Effects and Adverse Reactions
Left Ventricular Function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surgical management of post-myocardial infarction ventricular tachyarrhythmia by myocardial debulking, septal isolation, and myocardial revascularization. / Bolooki, H.; Palatianos, G. M.; Zaman, L.; Thurer, Richard J; Luceri, R. M.; Myerburg, Robert J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 92, No. 4, 01.12.1986, p. 716-725.

Research output: Contribution to journalArticle

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